Philosophy and Purposes of Distance Education

In considering how best to tackle this topic, I ultimately decided that in Nebraska the best approach is usually the most straight forward one. Given that much of the conversation about distance education is filled with myth and marketing hype, I decided what we could best contribute to the conversation would be the facts. While some of the other authors may have a better in-depth grasp of distance education opportunities and realities in Nebraska, Erik and I come as native Nebraskans with a good understanding of the history, economy, communities and cultures in our home state. My early faculty career here at UNL included producing thousands of radio and television programs in home economics and agricultural areas including a weekly educational television program in consumer affairs. I spent approximately 20 years of my career outside Nebraska in the U.S. Department of Agriculture in international training and development positions and as head of Communication, Information and Technology for the USDA Extension Service. Six of those 20 years were spent in Tanzania, East Africa, establishing a large human resource development program. My academic degrees are in journalism, nutrition and adult and continuing education - all from UNL. My current position as president of the ADEC distance education consortium which includes approximately 55 state university and land grant college members provides a unique perspective on the field of distance education locally, nationally and internationally. Erik France, who is assisting me in this work, is a journalism and business graduate from UNL and is currently doing his masters degree in the Department of Agricultural Leadership, Education and Communication. Erik conducted a series of Nebraska interviews related to the issues we were asked to cover. I also think he provides a youthful, up and coming perspective that is important for us to hear. We also consider this paper to be a draft, a document to stimulate those of you attending this conference and others who may want to contribute ideas following this conference on our ADEC website. We posted the paper to the website - http://www.adec.edu and would welcome additional insights that will assist us in completing the document by November 15. We have chosen to organize the document around five propositions - for each of these, I will provide rationale and discussion material, Erik will then provide perspectives from his interviews that relate and then we will ask for reactions from those of you in this room

The Chest Pain Choice trial: a pilot randomized trial of a decision aid for patients with chest pain in the emergency department

Background: Chest pain is a common presenting complaint in the emergency department (ED). Despite the frequency with which clinicians evaluate patients with chest pain, accurately determining the risk of acute coronary syndrome (ACS) and sharing risk information with patients is challenging. The aims of this study are (1) to develop a decision aid (CHEST PAIN CHOICE) that communicates the short-term risk of ACS and (2) to evaluate the impact of the decision aid on patient participation in decision-making and resource use. Methods/Design: This is a protocol for a parallel, 2-arm randomized trial to compare an intervention group receiving CHEST PAIN CHOICE to a control group receiving usual ED care. Adults presenting to the Saint Mary's Hospital ED in Rochester, MN USA with a primary complaint of chest pain who are being considered for admission for prolonged ED observation in a specialized unit and urgent cardiac stress testing will be eligible for enrollment. We will measure the effect of CHEST PAIN CHOICE on six outcomes: (1) patient knowledge regarding their short-term risk for ACS and the risks of radiation exposure; (2) quality of the decision making process; (3) patient and clinician acceptability and satisfaction with the decision aid; (4) the proportion of patients who decided to undergo observation unit admission and urgent cardiac stress testing; (5) economic costs and healthcare utilization; and (6) the rate of delayed or missed ACS. To capture these outcomes, we will administer patient and clinician surveys after each visit, obtain video recordings of the clinical encounters, and conduct 30-day phone follow-up. Discussion: This pilot randomized trial will develop and evaluate a decision aid for use in ED chest pain patients at low risk for ACS and provide a preliminary estimate of its effect on patient participation in decision-making and resource use